ABSTRACT
Patients with immunodeficiency-associated vaccine-derived poliovirus (iVDPV) are potential poliovirus reservoirs in the posteradication era that might reintroduce polioviruses into the community. We update the iVDPV registry in Iran by reporting 9 new patients. In addition to national acute flaccid paralysis surveillance, cases were identified by screening nonparalyzed primary immunodeficiency (PID) patients. Overall, 23 iVDPV patients have been identified since 1995. Seven patients (30%) never had paralysis. Poliovirus screening accelerated the iVDPV detection rate in Iran after 2014.The iVDPV infection rate among nonparalyzed patients with adaptive PID was 3.1% (7/224), several folds higher than previous estimates. Severe combined immunodeficiency patients had the highest risk for asymptomatic infection (28.6%) compared with other PIDs. iVDPV2 emergence has decreased after the switch from trivalent to bivalent oral poliovirus vaccine in 2016. However, emergence of iVDPV1 and iVDPV3 continued. Poliovirus screening in PID patients is an essential step in the endgame of polio eradication.
Subject(s)
Poliomyelitis/epidemiology , Poliomyelitis/etiology , Poliovirus Vaccines/adverse effects , Poliovirus/immunology , Primary Immunodeficiency Diseases/complications , Primary Immunodeficiency Diseases/epidemiology , Adolescent , Adult , Asymptomatic Diseases , Child , Child, Preschool , Female , Humans , Infant , Iran/epidemiology , Male , Mass Screening , Outcome Assessment, Health Care , Poliomyelitis/prevention & control , Poliomyelitis/virology , Poliovirus Vaccines/immunology , Primary Immunodeficiency Diseases/therapy , Public Health Surveillance , Registries , Symptom Assessment , Vaccination , Young AdultABSTRACT
The use of oral poliovirus vaccine in a worldwide scale has led to a 99.9% decrease in annual incidence of wild-type poliomyelitis and the eradication of serotype 2 poliovirus. However, the emergence of vaccine-derived polioviruses (VDPVs) is endangering the eradication program. Patients with combined immunodeficiencies are at increased risk of both vaccine-associated poliomyelitis and prolonged asymptomatic infection with immunodeficiency-associated VDPVs (iVDPVs). Herein, we present a severe combined immunodeficiency patient with prolonged and asymptomatic iVDPV infection. He continued to shed poliovirus during immunoglobulin replacement therapy and cleared the infection following successful hematopoietic stem cell transplantation (HSCT). To explain the efficiency of HSCT in clearing the infection, we reviewed the literature for all reports of HSCT in iVDPV-excreting patients and discussed novel ideas about the role of different immune mechanisms, including cell-mediated interactions, in mounting immune responses against poliovirus infections. This study could provide further insights into the immune mechanisms contributing to the clearance of enteroviral infections.
Subject(s)
Hematopoietic Stem Cell Transplantation , Poliomyelitis/etiology , Poliomyelitis/therapy , Poliovirus Vaccine, Oral/adverse effects , Adaptive Immunity , Child, Preschool , Humans , Immune Reconstitution , Immunity, Innate , Immunologic Deficiency Syndromes/complications , Immunologic Deficiency Syndromes/diagnosis , Immunologic Deficiency Syndromes/immunology , Immunologic Deficiency Syndromes/therapy , Male , Poliomyelitis/diagnosis , Poliomyelitis/virology , Poliovirus/immunology , Poliovirus Vaccine, Oral/administration & dosage , Time Factors , Treatment OutcomeABSTRACT
Purpose: Artificial intelligence (AI) technology is being rapidly adopted into many different branches of medicine. Although research has started to highlight the impact of AI on health care, the focus on patient perspectives of AI is scarce. This scoping review aimed to explore the literature on adult patients' perspectives on the use of an array of AI technologies in the health care setting for design and deployment. Methods: This scoping review followed Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR). To evaluate patient perspectives, we conducted a comprehensive literature search using eight interdisciplinary electronic databases, including grey literature. Articles published from 2015 to 2022 that focused on patient views regarding AI technology in health care were included. Thematic analysis was performed on the extracted articles. Results: Of the 10,571 imported studies, 37 articles were included and extracted. From the 33 peer-reviewed and 4 grey literature articles, the following themes on AI emerged: (i) Patient attitudes, (ii) Influences on patient attitudes, (iii) Considerations for design, and (iv) Considerations for use. Conclusions: Patients are key stakeholders essential to the uptake of AI in health care. The findings indicate that patients' needs and expectations are not fully considered in the application of AI in health care. Therefore, there is a need for patient voices in the development of AI in health care.
ABSTRACT
Typical chest CT findings in COVID-19 have been described as bilateral peripheral ground glass opacities, with or without consolidation. Halo sign and reversed halo sign have been reported as atypical imaging findings in this disease. However, to the best of our knowledge, combined presence of these signs has never been reported before. Herein, we present a COVID-19 patient with numerous atypical target-shaped, combined halo and reversed halo pulmonary lesions, in the absence of any other underlying disease.